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目的探讨80岁以上老老年原发性高血压患者24 h动态血压节律及颈动脉粥样硬化对认知功能损害的影响。方法老老年原发性高血压受试者196例进行24 h动态血压及颈动脉超声监测,使用中文版简易智能状态检查表(MMSE)对受试者进行认知功能调查,MMSE总分范围为0～30分。结果血压昼夜节律与颈动脉粥样硬化对MMSE得分有显著影响,且有交互作用(F=5.937,P<0.05)。颈动脉粥样硬化者MMSE得分低于颈动脉非粥样硬化者[(19.5±2.1)比(23.1±3.0),P<0.01]。血压昼夜非杓型节律者MMSE得分低于血压昼夜杓型节律者[(19.7±2.3)比(22.9±3.1),P<0.01]。杓型血压昼夜节律与颈动脉硬化对MMSE中注意力和计算力及回忆力方面,有显著的交互作用(P<0.01),但对定向力、记忆力及语言表达能力方面无交互作用。结论血压昼夜节律减弱或消失及颈动脉粥样硬化,对老老年原发性高血压患者的认知功能损害有协同作用。
Objective To investigate the effects of 24 h ambulatory blood pressure rhythm and carotid atherosclerosis on cognitive impairment in elderly patients with essential hypertension over 80 years old. Methods A total of 196 elderly essential hypertension subjects underwent ambulatory blood pressure monitoring and carotid ultrasonography at 24 hours. MMSE was used to investigate the cognitive function of the subjects. MMSE score range was 0 ~ 30 minutes. Results The circadian rhythm of blood pressure and carotid atherosclerosis had a significant effect on MMSE scores, and had an interaction (F = 5.937, P <0.05). The MMSE score of carotid atherosclerosis was lower than that of carotid artery non-atherosclerosis [(19.5 ± 2.1) vs (23.1 ± 3.0), P <0.01]. MMSE scores of diurnal non-dipper rhythm were lower than those of diurnal dipper rhythm [(19.7 ± 2.3) vs (22.9 ± 3.1), P <0.01]. Dipper blood pressure circadian rhythm and carotid atherosclerosis had significant interaction (P <0.01) in attention and calculation of memory and memory in MMSE, but no interaction on orientation, memory and verbal ability. Conclusion The decrease or disappearance of circadian rhythm of blood pressure and carotid atherosclerosis have synergistic effects on cognitive impairment in elderly patients with essential hypertension.